Assisted Living Medication Management: Medication Administration

The philosophy of assisted living is one of individualizing and maximizing consumer independence, choice, privacy and dignity. Facilities often consider medication administration their responsibility and are hesitant to relinquish control. However, it is expected that assisted living residents be encouraged and allowed to maintain as much independence as possible, including the right to retain control of their medications. A resident with the mental and physical capacity to develop increased independence in medication administration should be supported with self-administration instruction.

When residents cannot self-administer medications, facility staff may need to administer medications. When staff administer medications staff and facility may have requirements for training, documentation, assessment, monitoring, packaging of medications, storage and disposal.

Self-
Administration

Self-administration of medication suggests that individuals are functionally and cognitively competent to take and manage their own medications independently. Residents who wish to self-administer medications must be assessed to determine if they have the ability to do so safely. A thorough assessment may include such factors as dexterity, comprehension, recall and visual acuity. Residents should be re-assessed at least annually, and whenever there is a change in their physical, cognitive, functional status or desire to self-administer medications.

Tools

The following websites have a listing of assessment tools. Some are readily available and others you may need to purchase or work with your consultant pharmacist to obtain:

Relevant Regulations

Adult Day Care (ADC):
Certification Standard I.F.(1)
Certification Standard I.F.(2)

Family ADC:
Certification Standard I.D.(1)
Certification Standard I.D.(2)

Adult Family Home (AFH):
Wis. Admin. Code § DHS 88.06((3)(c)
Wis. Admin. Code § DHS 88.07(3)(c)

Residential Care Apartment Complex (RCAC):
Wis. Admin. Code § DHS 89.26(2)(c)
Wis. Admin. Code § DHS 89.26(3)(b)
Wis. Admin. Code § DHS 89.34(16)

Community-Based Residential Facility (CBRF):
Wis. Admin. Code § DHS 83.35(1)(c)2
Wis. Admin. Code § DHS 83.37(1)(c)
Wis. Admin. Code § DHS 83.37(1)(f)2
Wis. Admin. Code § DHS 83.37(2)(a)1
Wis. Admin. Code § DHS 83.37(2)(a)2
Wis. Admin. Code § DHS 83.37(2)(a)3

Staff
Training

Staff training is a vital component in the delivery of safe resident care. While regulations may differ according to provider type, it remains essential that sufficient staff training is provided to establish a successful medication management system. Inadequately trained staff increases the risk of medication errors that can lead to negative outcome, including death.

Medication administration is a core component of staff training and in many circumstances in assisted living is a task delegated to unlicensed staff by a Registered Nurse.

Resources

Relevant Regulations

ADC:
Certification Standard I.F.(1)

Family ADC:
Certification Standard I.D.(1)

AFH:
Wis. Admin. Code § DHS 88.04(5)(a)
Wis. Admin. Code § DHS 88.04(5)(b)
Wis. Admin. Code § DHS 89.23(4)(a)1
Wis. Admin. Code § DHS 89.23(4)(a)2

CBRF:
Wis. Admin. Code § DHS 83.20(1)(a)
Wis. Admin. Code § DHS 83.20(2)(d)
Wis. Admin. Code § DHS 83.21
Wis. Admin. Code § DHS 83.22
Wis. Admin. Code § DHS 83.24(6)
Wis. Admin. Code § DHS 83.25

Documentation

Documentation is an important component of medication administration. Documentation related to medication administration should include the following:

  • Physician’s orders
  • Transcription of orders
  • Medication administration record, including scheduled and PRN medications
  • Effect of medications, including the monitoring of side effects
  • Controlled medication records
  • Pharmacy reviews
  • Review of psychotropic medications
  • Disposal
  • Staff medication training
  • Medication errors

Resources

Relevant Regulations

ADC:
Certification Standard I.F.(3)(f)

Family ADC:
Certification Standard I.D.(3)(f)

AFH:
Wis. Admin. Code § DHS 88.07(3)(d)
Wis. Admin. Code § DHS 88.07(3)(e)1
Wis. Admin. Code § DHS 88.07(3)(e)2

CBRF:
Wis. Admin. Code § DHS 83.37(1)(a)
Wis. Admin. Code § DHS 83.37(1)(d)
Wis. Admin. Code § DHS 83.37(1)(g)3
Wis. Admin. Code § DHS 83.37(1)(h)1
Wis. Admin. Code § DHS 83.37(1)(i)3
Wis. Admin. Code § DHS 83.37(1)(k)1
Wis. Admin. Code § DHS 83.37(2)(d)

Communication

Communicating and reporting changes to a resident’s prescribing practitioner related to health and medication is critical. Reports to a resident’s prescribing practitioner, as well as to the resident’s guardian or designated representative could include a change in condition, medication error, adverse reaction, medication dosage change, etc. Failure to communicate and report may compromise a resident’s health, safety or welfare, and could result in negative outcome to the resident.

Relevant Regulations

ADC:
Certification Standard I.F.(3)

Family ADC:
Certification Standard I.D.(3)

AFH:
Wis. Admin. Code § DHS 88.07(2)(b)5
Wis. Admin. Code § DHS 88.07(2)(b)6
Wis. Admin. Code § DHS 88.07(3)(c)

CBRF:
Wis. Admin. Code § DHS 83.12(5)(a)
Wis. Admin. Code § DHS 83.37(1)(a)
Wis. Admin. Code § DHS 83.37(1)(e)1
Wis. Admin. Code § DHS 83.37(1)(e)2
Wis. Admin. Code § DHS 83.37(1)(e)3
Wis. Admin. Code § DHS 83.37(1)(f)1
Wis. Admin. Code § DHS 83.37(1)(f)2
Wis. Admin. Code § DHS 83.37(1)(k)2
Wis. Admin. Code § DHS 83.37(1)(L)

Resources

FAQs

1. Does medication administration in a RCAC require RN delegation?

Yes. Wis. Admin. Code § DHS 89.13(21) “Medication administration” means giving or assisting tenants in taking prescription and nonprescription medications in the correct dosage, at the proper time and in the specified manner. Wis. Admin. Code § DHS 89.13(22) “Medication management” means oversight by a nurse, pharmacist or other health care professional to minimize risks associated with use of medications. Medication management includes proper storage of medications; preparation of a medication organization or reminder system; assessment of the effectiveness of medications; monitoring for side effects, negative reactions and drug interactions; and delegation and supervision of medication administration. Wis. Admin. Code § DHS 89.23(4)(a)2. Nursing services and supervision of delegated nursing services shall be provided consistent with the standards contained in the Wisconsin nurse practice act. Medication administration and medication management shall be performed by or, as a delegated task, under the supervision of a nurse or pharmacist.

2. Can a CBRF hire a nurse who only delegates injections so that the CBRF can have residents on insulin?

Regulations in a CBRF require RN delegation if injections are administered by unlicensed staff. In addition if there is a RN who meets delegation/supervision requirements the insulin can be in a vial or insulin pen. If the RN does not meet supervision requirements then medications need to be in unit dose packaging.

A CBRF could hire an RN who only delegates insulin injections. However it is likely the RN does not meet supervision requirements and therefore insulin would need to be in unit dose packaging which would be difficult to meet. So although a CBRF could hire a RN to delegate only insulin injections it is very difficult for the facility to comply with the regulations in this circumstance.

Wis. Admin. Code § DHS 83.37(2)(e) Other administration. Injectables, nebulizers, stomal and enteral medications, and medications, treatments or preparations delivered vaginally or rectally shall be administered by a registered nurse or by a licensed practical nurse within the scope of their license. Medication administration described under sub. (2) (e) may be delegated to non-licensed employees pursuant to s. N 6.03 (3).

Wis. Admin. Code § DHS 83.37(2)(b) Medication administration supervised by a registered nurse, practitioner or pharmacist. When medication administration is supervised by a registered nurse, practitioner or pharmacist, the CBRF shall ensure all of the following:

  1. The registered nurse, practitioner or pharmacist coordinates, directs and inspects the administration of medications and the medication administration system.
  2. The registered nurse, practitioner or pharmacist participates in the resident's assessment under s. DHS 83.35 (1) and development and review of the individual service plan under s. DHS 83.35 (3) regarding the resident's medical condition and the goals of the medication regimen.
Last Revised: March 2, 2018